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Pertussis proliferation has Mass. health providers worried

By Katie Lannan, klannan@lowellsun.com

Updated:
12/07/2012 08:18:17 PM EST

LOWELL -- It's an illness usually thought of only when checked off on a child's required vaccination list, but a nationwide doubling of cases has health officials listening more closely for the distinctive sound of whooping cough.

"People have forgotten how dangerous these childhood diseases like whooping cough can be, because they haven't had experience with them," said Lowell Health Department Director Frank Singleton. "No one has that exposure since vaccines have really dropped their levels down."

The 560 cases of the respiratory ailment confirmed in Massachusetts so far this year is a dramatic jump from the 273 cases confirmed throughout all of 2011, said Kevin Cranston, director of the state Department of Public Health's Infectious Disease Bureau.

The state also saw its first infant whooping cough death in a decade earlier this year.

Whooping cough, or pertussis, is a bacterial infection resembling a cold, but with a nagging cough that usually lasts for about six weeks. The cough can linger for months, however, and young children are particularly at risk.

"It really is an area of serious concern for us," said Cranston. "All year long, even in the summer, when we don't normally hear about pertussis as much, we've been getting reports. We're tracking it very carefully and coordinating with the Centers for Disease Control."

The spike within the state parallels a nationwide uptick, Cranston said.

According to the U.S.

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Centers for Disease Control, whooping cough rates vary annually, peaking every three to five years. The last peak was in 2010, with 27,550 cases reported, up from 16,858 the previous year. In 2011, 18,719 cases were reported.

Through Nov. 17, more than 36,000 reports of whooping cough cases had come through the CDC's system this year.

According to CDC data, 13 states, including Massachusetts, saw their whooping cough numbers multiply between two and three times, and 24 states report a more than threefold increase. The only state to not have a spike in whooping cough is California.

Cranston said that unlike previous outbreaks in some West Coast states, the local rise can't be attributed to children not receiving their vaccines.

"We have some of the best childhood immunization rates in the country, but pertussis is one of those diseases where it's just as important to vaccinate the adults in the household," Cranston said.

In 2011, the state's adult pertussis-vaccination rate was just under 20 percent.

Because the vaccine against whooping cough, which also prevents tetanus and diphtheria, is newer, adults would not have received it as part of their childhood immunization schedules, Cranston said.

This combination vaccine was first licensed in 2005. Before that, a shot protecting against the three diseases was given once to children under the age of 7, with tetanus and diphtheria boosters recommended every 10 years thereafter.

The newer vaccine "doesn't have the lasting immunity but is better tolerated," Cranston said. Those who receive it may be less protected against the illness after a few years, which could contribute to a spike in cases beyond the usual variance.

Christine West, public health nurse for Billerica, said another potential explanation of the uptick is more frequent reporting and testing of suspected cases.

Billerica has seen seven confirmed cases of whooping cough so far this year, West said. Last year, the town had two cases, down from 13 in 2010.

Lowell's Singleton said there have been two cases reported in the city since September. The Health Department offers free whooping cough vaccines to residents age 19 or older on a walk-in basis on Friday afternoons, or by appointment.

In Fitchburg, no cases of whooping cough have been reported this year, so the city is not offering vaccines. Health Director Stephen Curry said his department would be ready to do so if the need arises, thanks to an 11-community partnership called the Montachusett Public Health Network.

"We could have a clinic at the drop of a hat," Curry said of the network, which shares public-health resources among the municipalities in its district, including Fitchburg and Leominster.

Chelmsford's manager of health-care services, Sue Rosa, said she purchases and administers the vaccines for residents who can't get the shot from their physicians.

"I'm a back-up, if you will," said Rosa, a registered nurse.

Not all doctors' offices stock the vaccine regularly. In recent years, Rosa said, doctors who treat adults have become more likely to carry the shot as health practitioners advocate for all age groups to receive the vaccine.

"They're really trying to push that adults, parents, grandparents, anyone who might come in close contact with an infant, get the vaccine," Rosa said.

Five cases of whooping cough have been reported in Chelmsford this year, up from one last year and two in 2010.

"It's not an epidemic here," Rosa said. "Yes, I've had more cases, but I believe that with the education that is out there, we're doing much better at getting people immunized and therefore protecting infants.

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